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Hirschsprung's-associated Enterocolitis
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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If the patient is less than four weeks out from surgery, fellows should discuss the rectal exam with an attending surgeon prior to performing it — Meera Kotagal, Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline... · 2:00
Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...
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Dr. Meera Kotagal discusses one approach to the management of known or suspected Hirschsprung's-associated enterocolitis. Here is more detail on the guideline in place at Cincinnati Children's Hospital [June 2019].
video · Jul 2019
Not everyone may need Botox at the time of pull-through, but there may be a subset of patients with predisposition to enterocolitis who would benefit from Botox as part of treatment strategy. — Caitlin Smith, Update Course Rewind: Botox in Hirschsprung Disease 2023 · 4:34
Update Course Rewind: Botox in Hirschsprung Disease 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Botox in Hirschsprung Disease". Joining the discussion
video5:55 · Feb 2024
Gastroenterologists and surgeons must know the anatomy of the original pull-through procedure (Swabe, Swenson, or Duhamel) when evaluating obstructed patients — Marc Levitt, The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2 · 18:32
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
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We've discussed Hirschsprung Disease at length before but today we visit a complicated topic that many deal with, obstruction. Dr. Levitt and Dr. Frischer speak with Dr. Rentea from Children's Mercy at Kansas City about the obstructed patie
podcast24:11 · Aug 2021
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
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We've discussed Hirschsprung Disease at length before but today we visit a complicated topic that many deal with, obstruction. Dr. Levitt and Dr. Frischer speak with Dr. Rentea from Children's Mercy at Kansas City about the obstructed patie
podcast21:29 · Sep 2021
Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
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Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)Join us
podcast17:08 · Sep 2026
Expert statements from the recordings in this collection.
Suspected Hirschsprung's-associated enterocolitis (HAEC) Treatment Guideline...
Papers by Pastor et al and Gosain et al outline frameworks and clinical guidelines for management of enterocolitis
The guideline is most appropriate for patients with either known or suspected Hirschsprung's who present with GI symptoms and/or fever
GI symptoms in HAEC include abdominal distension, vomiting, no or minimal stool, foul smelling stool, or explosive diarrhea
Meera Kotagal0:21
Systemic signs of concern include fever, lethargy, age-adjusted tachycardia, tachypnea, hypotension, or oliguria
Meera Kotagal0:21
Patients should be seen and evaluated as soon as possible, ideally within one hour by someone with clinical expertise such as a surgical fellow or attending
The exam should include a rectal exam
If the patient is less than four weeks out from surgery, fellows should discuss the rectal exam with an attending surgeon prior to performing it
Irrigations should not be delayed for patients to get an x-ray
Irrigations should be repeated as frequently as every eight hours, but even every six or four hours as needed for sicker patients
Abdominal films should be obtained upon arrival and then repeated again after an irrigation to demonstrate adequate decompression
Abdominal films can be repeated throughout the course of the hospitalization as clinically necessary
Patients should be NPO and started on IV fluids to assist with resuscitation and hydration
Patients without systemic signs who are mostly clinically well can be maintained on either IV or oral flagyl during hospitalization
All patients who are vomiting should be on IV antibiotics
Patients with systemic signs who are sicker need broad spectrum antibiotics, specifically Zosyn and flagyl at Cincinnati Children's
All patients should get a CBC and a basic metabolic panel
A venous blood gas should be obtained for sicker patients to help evaluate resuscitation needs
Patients with systemic signs should be evaluated for potential admission to the ICU
After an admission for enterocolitis, patients are continued on metronidazole and irrigations for a few weeks and then slowly tapered
Underlying anatomic issues such as a stricture or a transition zone pull through must be addressed to prevent recurrent enterocolitis
Meera Kotagal5:00
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
Post-pull-through obstruction can be caused by stricture, twist (any pull-through type), Soave cuff (Soave procedure), Duhamel spur or non-functional distended segment (Duhamel procedure), or non-functional segment (Rehbein procedure).
Hira Ahmad6:45
In obstructed Hirschsprung patients, the colon fills with liquid stool with severe bacterial overgrowth, causing fluid loss into the bowel lumen, hypovolemia, and bacterial translocation/bacteremia, all occurring without passage of stool.
Marc Levitt10:10
Enterocolitis can occur before surgery, after surgery, and even after successful surgery in babies who don't relax their sphincters and hold stool so efficiently they develop enterocolitis.
Marc Levitt11:06
For a patient with prior Hirschsprung diagnosis presenting sick, assume Hirschsprung-associated enterocolitis; treatment with rectal irrigations, IV fluids, and antibiotics will not cause harm even if the diagnosis is different (e.g., Crohn's disease, E. coli enterocolitis).
Jason Frischer12:06
Post-pull-through enterocolitis within the first 3 months occurs in about 20% of patients, based on a study from Cincinnati and Columbus.
Marc Levitt13:58
Families should not undergo Hirschsprung pull-through surgery until they can demonstrate ability to perform rectal irrigations, and they should be discharged with supplies to perform irrigations at home.
In rare circumstances where a patient is too ill and sedation in the ER doesn't work, go to the OR under general anesthesia for irrigation until the patient improves; occasionally an ileostomy is needed to get the child out of trouble and work up the pull-through problem later.
Marc Levitt16:30
On contrast enema, it is important to look at the presacral space (space between the hollow of the sacrum and the pull-through); a widened presacral space is an abnormal finding.
Marc Levitt19:14
On contrast enema, if the catheter is inserted too high or the balloon is under too much pressure, distal pathology cannot be easily ascertained.
Rebecca Rentea20:48
A lateral view on contrast enema is important because it provides significant information about the presacral space and distal rectum anatomy.
Jason Frischer19:43